The nature of the regime naturally includes the body double. This was highly effective before the advent of biometric image processing that can use as input any photo or video. Totality of control prevents detection of the double by excluding all cameras, with separation of the audience by large distance. A body double that passes casual inspection at a distance risks exposure with image processing. The official photo does not count.

So there is more to this than the simple question of whether the event occurred. While North Korea could have simply reported an event that did not occur, it has resources to do much more.

It is the nature of the press to report South Korea ‘s representations that Kim is well at face value, even though Administration sources hint at the opposite. This site is about open source intelligence, so we must note that South Korean statements have no informative value. Their statements could be

Mandated by source protection, the first obligation of all intelligence agencies.

Due to faulty intelligence, as is sometimes provided by a double agent.

Result from faulty analysis.

Hence S. Korean statements to present have no weight in the estimate of this problem. What does?

Cautious U.S. statements, which, saying less, inform more.

The non-appearance of Kim in any format accepted as record outside of North Korea.

Kim’s health history. His smoking, obesity, and metabolic syndrome make him a sitting duck.

Long time readers of this blog are familiar with the technique first described by Benjamin Franklin, of counting the pros and cons, with equal weight to each. For an application, see U.S. Strike on North Korea? Prediction Update. Depending upon how you count, there are between 5 and 9 independent pros, favoring Kim’s severe incapacitation.

In spite of the obvious desire of North Korea to contradict this with a “con”, their count is zero. The official photo does not count.

Media have been worrying about the terrible things that could happen without Kim. There hasn’t been any mention of the upside. Who are they kidding? This would be great news for North Korean Munchkins. I’ve got the song ready:

Not long ago, augury, the divination of the future, was the preoccupation of the marginalized or foolish. Though it now has a stronger attraction, it’s best to keep it as wish, not action. It can also inspire painters and poets, who don’t paint or write to be understood.

The popular maelstrom picks up on something like this with proclamations of worthlessness and political finger pointing. The value of this study is too small to become part of that. It usefully warns and reminds the clinician that:

Hydroxychloroquine is a dangerous drug.

If it does work, there is likely to be a tight regime, with the narrow therapeutic index characteristic of drugs of the pre-antibiotic era. With some of these drugs, the range between the effective dose and the lethal dose was exceedingly small.

No one has any idea how to dose. Experimental dosage is based on toxicity to the malaria parasite, entirely different from the job of chaperoning zinc ions into an epithelial cell.

Quoting,

In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19.

The words are correct, but should not be confused with “found evidence that [the combinations] did not reduce the risk of mechanical ventilation in patients .” The study found nothing. either pro or con.

The link contains reader comments, which are well thought out. One factoid draws attention. Quoting,

Rates of ventilation in the HC, HC+AZ, and no HC groups were 13.3%, 6.9%, 14.1%, respectively.

This is a red flag.The ventilation rate for HC+AZ recipients was half that of the others. There are two ways to take this:

The HC+AZ recipients did not enjoy a statistically meaningful reduction in mortality, so, so what?

Something is wrong with the data.

Whenever we analyze statistical data, we look for “outliers”, data points are not coherent with the trend. The 6.9% could be the result of outliers in a too-small, invalid trial, or it could represent a unidentified cohort with salient characteristics.

Three choices are available:

Continue the study until it is large enough that the salient characteristics of the cohort can be identified.

Decide that no cohort exists. Exclude messy data as outliers.

Decide that the data does not reach the threshold at which statistics can be applied.

This study does not reach the threshold of statistical validity, and should not become part of public policy debate. It has value only as a caution to the clinician.

The US is monitoring intelligence that North Korea’s leader, Kim Jong Un, is in grave danger after a surgery, according to a US official with direct knowledge…Kim received the cardiovascular system procedure because of “excessive smoking, obesity, and overwork,” according to the news site, and is now receiving treatment in a villa in Hyangsan County following his procedure.

Kim Jong Un is age 37, unusually youthful for a bypass. The procedure is, with high probability, balloon angioplasty, perhaps combined with stent placement. Although these are very popular procedures, whether they improve long term survival over purely medical treatment has been questioned by some studies.

A common complication of these procedures occurs when small pieces of arterial plaque break free, lodging in small blood vessels of the brain. The resulting ischemia causes brain damage, from slight “brain fog”, to apparent, to severe.

This scenario would explain the divergences of the CNN and Reuters sources:

It may have originally appeared critical, with danger to life receding after treatment with clot busters.

US intelligence officials believe that King Salman has been kept apart from his wife Princess Fahda bint Falah Al Hathleen for several years, on the orders of their son Prince Mohammad bin Salman.[109] …

Yet up to the recent, Salman is credited in the media with command authority. With little or no open source contradiction, this indicates a system of ruling legitimacy that “splints” the incompetent.

António de Oliveira Salazar, dictator of Portugal from 1932 to 1968, had an incapacitating stroke that resulted in his immediate removal from office. He lived until 1970. He became lucid during this interval. Out of popular respect, he was never told he had been removed from office. He died in this illusion.

Some regard COVID-19 as a warning to prepare for the eventuality of a far more lethal plague. I wondered whether dramatization of this threat would serve a good purpose. I think it will, provided the drama is tempered with science.

(YouTube) The Satan Bug is a 1965 movie that anticipates an artificial virus that can end all life on earth. In the real world, natural selection prevents this from happening. A virus that has no person or creature to infect dies out. A virus needs hosts. There is a natural balance to such things.

In the natural world, in exceptional cases, the cap on virulence loosens temporarily, until the natural balance resumes. In the laboratory of bio-warfare, where hosts can be guaranteed, there is no equivalent cap. A virus is not alive; it is a machine. The only limitation to virulence is the complexity of viral machinery that can be devised to fit in the mechanism that opens the host cell. Some refer to modifications of added capability as gain of function.

What is the limit of virulence? Without the need to preserve some hosts for future infection, is there a limitation to all viral machinery? Is it Ebola or a rabies virus, packaged for airborne delivery? Can stealth aspects be added, as observed with COVID-19 ? What of a constellation of virusoids that co-infect and extend the virulence of the engineered virus?

As a universal killer of all life, the Satan bug is almost impossible. Fiction takes dramatic license. Life fights back with genetic diversity. But the border of reality is unknown. Vaccine technology has made great strides. The methods of trialing a vaccine have not; they do not reflect knowledge at molecular level that was unknown in the whole-virus live-or-killed vaccine era.

This time, the cost in lives of the prolonged vaccine trials will be in the low millions, or tens of millions. It could have been much worse. (Atlantic) Hic sunt dracones. There be dragons.

ISAC shares the concerns regarding the above article published recently in the International Journal of Antimicrobial Agents (IJAA). The ISAC Board believes the article does not meet the Society’s expected standard, especially relating to the lack of better explanations of the inclusion criteria and the triage of patients to ensure patient safety.

The IJAA is the official journal of the ISAC. Despite criticism, the article has not been retracted. Inferring the unstated, the study is too flawed and weak to establish anything, yet:

The article author is not accused of misconduct.

ISAC does not wish to discourage further studies of the same medications.

ISAC cannot escape human concern about the dire threat to the world.

The delicate words in red could use some interpretation. COVID-19 has one of the most variable courses of any disease, from asymptomatic to fatal. Ethics and triage challenge the neutrality of any human study.

The study estimated that 2.49% to 4.16% of people in Santa Clara Country had been infected with Covid-19 by April 1. This represents between 48,000 and 81,000 people, which is 50 to 85 times what county officials recorded by that date: 956 confirmed cases.

This number might not be just a testing issue. If you were to fill all the available beds in Santa Clara County, and compare outcomes with the NY hospital beds, and attempt the same care, the outcomes could be wildly different. This is why a control group is so important. And there is no answer to the words in red. There is currently no way to select study patients so they average to the same severity of disease.

In any given place, the more hospital beds are available, the less sick the patients will be on average. Even a blind study, with a control group can’t factor this out. Only big numbers in the study make a dent in it, and it isn’t foolproof.

Is this the end for hydroxychloroquine? Only as a wonder drug. Nothing is set in stone. It might:

Have prophylactic use, hopefully at a lower level than required for malaria, where serious threat to life exists.

Have some effectiveness if given within the first 48 hours of infection, requiring broad availability of rapid tests.

Be the research basis for a drug that concentrates in the lung.

After careful study, hydroxychloroquine might compare favorably with drug innovations of the pre-antibiotic era, the first half of the 20th century. Paul Ehrlich won a Nobel for Salvarsan, the arsenic based second cure for syphilis. (In a curious twist, the first cure for syphilis was deliberate infection with malaria.)

Positive thoughts. I tend to sympathize with China hawks, for reasons that I think of as rational. About 17 years ago, a study concluded that Americans would not pay an extra dime for a light bulb made in the U.S.A. In the indolent 90’s, up till 2010, the dollar store was China’s friendly ambassador. How can sentiment be mobilized for “buy American?”

With the guts ripped out of the manufacturing economy, many of us, myself included, wish for a Back to the Future solution. I would prefer that it be powered not by national prejudice, but by national preference. It’s wrong to hate a country for doing well. It’s right to love our country more.

Now switch to the negative. The research of the Wuhan Institute of Virology is not as unique or essential as the Post supposes. As far back as 2012, articles like (PubMed) Mechanisms of host receptor adaptation by severe acute respiratory syndrome coronavirus elucidated the mechanisms. For academicians, a popular gambit is to restudy a problem in hair-splitting detail until funding can no longer be obtained. The research referenced as valuable in the Post article is incremental to prior published efforts.

The unstated importance of the Wuhan Institute of Virology is the development of human resources, competence which could be directed towards bio-weapons development. Almost all “black” programs have unclassified precursors. Who thought it was smart to help China set up a BSL-4 facility? We’ve already seen what unweaponized COVID can do to an aircraft carrier.

Now, the ambiguous. If you’ve absorbed the above, it must be frustrating that the “escaped from a lab” idea is utterly unproveable. Even the likelihood is impossible to determine. It’s no help that COVID-19 is transmissible by asymptomatic carriers. At best, after some very complex analysis, someone may come up with a dubious number, like “30% chance it escaped from a lab”. I distrust such numbers, particularly when an issue becomes political, because the mutation of RNA is a frequent, random process that obscures its tracks with every jump to the next host.These are not betting odds.

Again, the positive. Consider that we don’t know how many cases we have, or what mutations exist. The problem has completely run away from us in our own country. It is entirely possible that COVID-19 came from a Wuhan lab, and China can’t determine this, or any other theory of origin.

The politicization of a question that cannot have a definite answer is the use of animus to influence trade policy. Bad vibes can be reciprocated. Trade, human rights, and geopolitics have their own legitimacies. They don’t need help from plague-inspired hate.

We got caught with our pants down. The blame should start here, and it should stop here.

“I think it is a coordinated effort from (the) Chinese government to control (the) narrative, and paint it as if the outbreak did not originate in China,” the researcher told CNN. “And I don’t think they will really tolerate any objective study to investigate the origination of this disease.”

To everybody outside of China, it’s too late to rewrite history. This does not vitiate the importance of the question of why Beijing has decided to try. Widely disparate motives are possible:

The Huanan Seafood Wholesale Market could be an example of severe regulatory incompetence, with graft lubricating commerce even when infection was evident.

There really are mass graves of village dead, or documented traffic of crematoriums working overtime, resulting from minimal medical care and cover-up. The misdeeds of local officials, these could still provoke national rage. Historic Chinese culture venerates the farmer, reflected in the Tang Criminal Code.

The data-intensive, technical collections that base IC efforts, possibly augmented by HUMINT, can’t be matched in open source. The logic is the same for both.

One purpose of this blog is to promote open-source analysis as skill that can be developed. Analysis is not a leap to an answer; it’s development of an inventory of questions. Some will be disposed of, others will lead to more questions, while some may lead to significant conclusions. So, questions:

On 18 December 2019, Ai came into contact with the first case of pulmonary infection showing “multiple patchy blurry shadows scattered in lungs” from a delivery person of Huanan Seafood Wholesale Market. On 27 December, she received a second patient, but this person had no history of contact of Huanan Seafood Wholesale Market. In the afternoon of 30 December, the test result of the second patient showed infection with a coronavirus. When she saw the words “SARS coronavirus,…

12/18 as the first official date is somewhat contradicted by the IC. Quoting Reuters,

As far back as late November, U.S. intelligence officials were warning that a contagion was sweeping through China’s Wuhan region, changing the patterns of life and business and posing a threat to the population, according to four sources briefed on the secret reporting.

A date difference of around around three weeks. How can this be resolved? Possibilities:

A hidden parallel care system in Wuhan, with a separate medical database. But how could it muster the diagnostic resources? How would it control the grapevine? It’s not impossible, but leaks would be expected.

A separate outbreak among rural communities that fed the Wuhan live animal market. Without the urban grapevine, local authorities could have concealed these outbreaks with minimal medical care and rapid burial.

Misdiagnosis on a massive scale, as happened in Moscow.

Mortality is a separate question. It could have been concealed by surreptitious editing of the medical records database. Does it fit with either of the above? Stepping back from this detail, in the period of late November to mid December, were there:

One outbreak, heavily managed, so that even physicians such as Ai Fen would be out of the loop?

Multiple outbreaks. Concealed by local authorities, or Beijing?

Overlapping outbreaks, which grew into each other? This allows under counting or over counting by sheer confusion.

Deceit, usually for domestic reasons, is typical of governments which descend from former communist states. The only surprise is honesty. Nevertheless, the date discrepancy is not resolved to satisfaction. In place of the above, a simple question will suffice: What the hell was going on?

We’re done with annoying questions. Open source has a few basic hand tools to offer, Occam’s Razor, and combinatorics. This may help to redefine the quest for Patient Zero. In most cases, it is a quixotic quest. In Wuhan, combinatorics shows this.

There is an analysis tool, the sum of probabilities, that has been taught to CIA analysts. It is analogous to Feynman diagrams. It assumes that the chance of an event is proportional to the sum of all the ways it could happen. The theory is very precise; the application is necessarily approximate.

Get the checkerboard out, to imagine a world of only 8 people. We want to know the origin of one case, the chain of transmission back to the first of these 8.

Number the red and black edges 1 to 8, the 8 inhabitants of this tiny world.

On the black edge, Number 4 is infected. We want to know the origin.

The infection proceeds from red to black.

Each step from red to black is a minimum of one unit of time.

You are permitted to draw a chain that duplicates a number, provided they are adjacent. For example, 1-2-2-2-2-2-2-4 is a valid chain of infection that implicates #1. But 1-2-3-2-2-2-2-4 is not, because it implies #2 was infected twice.

All the chains are assumed equally probable.

The order of the chain members matters.

What is the probability that Red #2 is the origin of #4’s infection?

It is the sum of all possible chains connecting Red #2 to Black #4, divided by the total number of possible chains that connect the Red side of the board to Black #4.

Skipping to the obvious answer evades the point of the exercise. The counting reveals a form of transmission where individual identity is meaningless, replaced from the outset by large-number statistics. The significance of Patient Zero is zero.

This model has little real-world utility. It appears that the Huanan Seafood Wholesale Market is an exception. Described as a slosh-pit of infectious blood and guts, it has intuitive use. Anybody can infect anybody, with back-and-forth animal-human-animal-human transfer likely. The model cannot be accurate, but it is compatible with multi-focal outbreaks, and the discrepancies noted by the IC.

There is always a Patient Zero. For the Wuhan outbreak, the significance of Patient Zero is supervened by the statistical characteristics of the Huanan market. These characteristics, not those of a Patient Zero, are determinant of what the IC may have identified as a multi-focal outbreak.

Not a lot in the CNN article is objectively wrong. The French study is shoddy. But long on opinion and short on facts, the article raises the question: Can the public be made to understand anything, or, as Walter Lippmann claimed, must public opinion remain under the wise care of the elite? I don’t know the answer to that either. But every article is an individual choice of these proportions: influence, as in “trust the experts”, and information. Could the popularity of anti-vaxer sentiment be an allergic reaction to an excess of influence, and a shortage of information?

The article pits “professional opinion of respected experts” [quotes mine, for effect] against a pol. With this focus, the article omits the self-knowledge of the experts about their expertise, their differences of opinion, and opportunities for innovation. This laser sharp experts-versus-Trump focus squeezes out every possible procedural innovation in drug studies. That’s why I quoted “professional opinion…” And so,

Author Cohen homogenized a subject which has both a core and a frontier, agreement and diversity. There is no mention of any difference of opinion, on how to conduct studies, within the medical community. Is this a possible state of affairs?

Possibly due to Cohen’s choice of “Boiled down to the essentials” she omits the meaning of “double blind”. Too complicated for the hoi-polloi? Let’s say it here: It means nobody knows who’s getting the real drug.

The efficacy of the drug is cast as a political question. As right or wrong as Trump may be, it is not, unless you (literally) want to argue politics with your last dying breath.

The article implies that in a duel between Trump and the experts, on whether the drug ultimately works, Trump is a bad bet. It depends upon how you like 50/50, or maybe 60/40. The complicated truth is:

Trump could be right, for the wrong reasons.

The experts could be wrong, for the right reasons.

It’s difficult for the press to make sense of in the editorial tradition of taking sides.

Hydroxychloroquine has activity against COVID-19 in the dish. It is a dangerous drug:

The therapeutic index, the range of the effective dosage, at least for the malaria parasite, is narrow.

Multi-system toxicity.

It is a cardiac antiarrhythmic agent, which, like most such drugs, can cause cardiac arrest when used with the wrong patient in the wrong dose, which may conflict with the dose for COVID-19.

The CNN article addresses this well, a small departure from influence with an insert of actual information.

Warning, before you scroll down. Three words are used that may offend some readers. One word has 3 letters, while two have 5. These words will be not be used in the context of any person, company, or politics. They are essential to discussion of the Scientific Method.